Form Il 532 2865 – Fill Out and Use This PDF

Form Il 532 2865 has a distinct purpose. It is a quintessential document used to identify important information regarding potential new members' eligibility for membership within an organization. Used by organizations worldwide, this form assists in deciphering the level necessary and eligibility of an individual looking to join the group. When presented with a completed Form IL 532 2865, reputable entities know immediately exactly what to look for: necessary documents that fulfill prerequisites for membership, required regulations to be filled out, and all other identifiers to consider when allowing the individual in question to become a part of their establishment.

Form Il 532 2865 PDF Details

Are you familiar with the Form Il 532 2865? If not, you should be. This form is used to report Illinois tax withholding and it's due on January 31st of each year. Failing to submit this form can result in hefty fines and penalties, so make sure you're ready to file by the end of January! In this blog post, we'll go over everything you need to know about the Form Il 532 2865. We'll discuss who needs to file it, what information needs to be included, and when it's due. By the end of this post, you'll be fully prepared to file your taxes for 2017!

Question	Answer
Form Name	Form Il 532 2865
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	628 apc apply for fesop ill form

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Illinois Environmental Protection Agency

Division Of Air Pollution Control -- Permit Section

P.O. Box 19506

Springfield, Illinois 62794-9506

Construction Permit Application

For a FESOP Source

(FORM APC628)

For Illinois EPA use only

BOA ID No.:

Application No.:

Date Received:

This form is to be used to supply information to obtain a construction permit for a proposed project involving a Federally Enforceable State Operating Permit (FESOP) or Synthetic Minor source, including construction of a new FESOP source. Other necessary information must accompany this form as discussed in the “General Instructions For Permit Applications,” Form APC-201.

Proposed Project

1.Working Name of Proposed Project:

2.Is the project occurring at a source that already has a permit from the Bureau of Air (BOA)?

Yes If Yes, provide BOA ID Number: __ __ __ __ __ __ __ __ __

3. Does this application request a revision to an existing construction permit issued by the BOA?

Yes If Yes, provide Permit Number: __ __ __ __ __ __ __ __

4.Does this application request that the new/modified emission units be incorporated into an existing FESOP issued by the BOA?

Yes If Yes, provide Permit Number: __ __ __ __ __ __ __ __

Source Information

5.Source name:*

6.Source street address:*

7. City:

8. County:

9. Zip code:

ONLY COMPLETE THE FOLLOWING FOR A SOURCE WITHOUT AN ID NUMBER.

10.Is the source located within city limits? If no, provide Township Name:

Yes

11.Description of source and product(s) produced: 12. Primary Classification Code of source: SIC: __ __ __ __ or NAICS: __ __ __ __ __ __

13. Latitude (DD:MM:SS.SSSS):

14. Longitude (DD:MM:SS.SSSS):

*If this information different than previous information, then complete a new Form 200-CAAPP to change the source name in initial FESOP application for the source or Form APC-620 for Air Permit Name and/or Ownership Change if the FESOP has been previously issued.

Applicant Information

15. Who is the applicant?

Owner

Operator

16. All correspondence to: (check one)
Owner	Operator	Source

17. Applicant’s FEIN:

18. Attention name and/or title for written correspondence:

This Agency is authorized to require and you must disclose this information under 415 ILCS 5/39. Failure to do so could result in the application being denied and penalties under 415 ILCS 5 et seq. It is not necessary to use this form in providing this information. This form has been approved by the forms management center.

IL 532-2865 APC628 9/07

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Page 1 of 4

Owner Information*

19.Name:

20.Address:

21. City:

22. State:

23. Zip code:

*If this information different than previous information, then complete Form 272-CAAPP for a Request for Ownership Change for CAAPP Permit for an initial FESOP application for the source or Form APC-620 for Air Permit Name and/or Ownership Change if the FESOP has been previously issued.

Operator Information (If Different from Owner)*

24.Name

25.Address:

26. City:

27. State:

28. Zip code:

Technical Contacts for Application

29. Preferred technical contact: (check one)	Applicant’s contact	Consultant

30. Applicant’s technical contact person for application:

31. Contact person's telephone number

32. Contact person's email address:

33. Applicant’s consultant for application:

34. Consultant's telephone number:

35. Consultant's email address:

Review Of Contents of the Application

36.Is the emission unit covered by this application already constructed?

If “yes”, provide the date construction was completed:

Note: The Illinois EPA is unable to issue a construction permit for a emission unit that has already been constructed.

Yes

37.	Does the application include a narrative description of the proposed		Yes	No
	project?

38.	Does the application contain a list or summary that clearly identifies		Yes	No
	the emission units and air pollution control equipment that are part

	of the project?
39.	Does the application include process flow diagram(s) for the project		Yes	No
	showing new and modified emission units and control equipment

	and related existing equipment and their relationships?
40.	If the project is at a source that has not previously received a		Yes	No
	permit from the BOA, does the application include a source

	description, plot plan and site map?
IL 532-2865 APC628 9/07		Printed on Recycled Paper		Page 2 of 4

Review Of Contents of the Application (continued)

41.	Does the application include relevant information for the proposed	Yes	No
	project as requested on Illinois EPA, BOA application forms (or	Yes	No

	otherwise contain all the relevant information)?
42.	Does the application identify and address all applicable or	Yes	No
	potentially applicable emissions standards, including:	Yes	No
	potentially applicable emissions standards, including:
	a. State emission standards (35 IAC Chapter I, Subtitle B);
	b. Federal New Source Performance Standards (40 CFR Part 60);
	c. Federal standards for HAPs (40 CFR Parts 61 and 63)?
43.	Does the application address whether the proposed project or the	Yes	No .	N/A
	source could be a major project for Prevention of Significant	Yes	No .	N/A

	Deterioration (PSD), 40 CFR 52.21?
44.	Does the application address for which pollutant(s) the proposed	Yes	No .	N/A
	project or the source could be a major project for PSD, 40 CFR	Yes	No .	N/A

	52.21?
45.	Does the application address whether the proposed project or the	Yes	No	N/A
	source could be a major project for “Nonattainment New Source	Yes	No	N/A

	Review,” (NA NSR), 35 IAC Part 203?
46.	Does the application address for which pollutant(s) the proposed	Yes	No	N/A
	project or the source could be a major project for NA NSR, 35 IAC	Yes	No	N/A

	Part 203?
47.	Does the application address whether the proposed project or the	Yes	No	N/A*
	source could potentially be subject to federal Maximum Achievable	Yes	No	N/A*
		* Source not major
	Control Technology (MACT) standard under 40 CFR Part 63 for	* Source not major
	Control Technology (MACT) standard under 40 CFR Part 63 for
	Hazardous Air Pollutants (HAP) and identify the standard that could	Project not major
	be applicable?
48.	Does the application identify the HAP(s) from the proposed project	Yes	No	N/A
	or the source that would trigger the applicability of a MACT	Yes	No	N/A

	standard under 40 CFR Part 63?
49.	Does the application include a summary of the current and the	Yes	No	N/A*
	future potential emissions of the source after the proposed project	Yes	No	N/A*
		* Applicability of PSD, NA NSR or
	has been completed for each criteria air pollutant and/or HAP	* Applicability of PSD, NA NSR or
		40 CFR 63 not applicable to the
	(tons/year)?	source’s emissions.
50.	Does the application include a summary of the requested permitted	Yes	No	N/A*
	annual emissions of the proposed project for the new and modified	Yes	No	N/A*
		* Project does not involve an
	emission units (tons/year)?	* Project does not involve an
	emission units (tons/year)?	increase in emissions from new or
		modified emission units.
51.	Does the application include a summary of the requested permitted	Yes	No	N/A*
	production, throughput, fuel, or raw material usage limits that	Yes	No	N/A*
		* Project does not involve an
	correspond to the annual emissions limits of the proposed project	* Project does not involve an
		increase in emissions from new or
	for the new and modified emission units?	modified emission units.
52.	Does the application include sample calculations or methodology	Yes	No
	for the emission estimations and the requested emission limits?	Yes	No

53.	Does the application address the relationships with and	Yes	No	N/A*
	implications of the proposed project for the source's FESOP?	Yes	No	N/A*
		*FESOP not yet issued.
		*FESOP not yet issued.
54.	If the application contains information that is considered a TRADE	Yes	No	N/A*
	SECRET, has such information been properly marked and claimed	Yes	No	N/A*

	and other requirements to perfect such a claim been satisfied in	* No information in the application is
	accordance with 35 IAC Part 130?	claimed to be a TRADE SECRET
	accordance with 35 IAC Part 130?

Note: “Claimed information will not be legally protected from disclosure to the public if it is not properly claimed or does not qualify as trade secret information.

IL 532-2865 APC628 9/07

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Review Of Contents of the Application (continued)

55.	If the source is located in a county other than Cook County, are two	Yes	No
	separate copies of this application being submitted?	Yes	No
	separate copies of this application being submitted?
56.	If the source is located in Cook County, are three separate copies	Yes	No
	of this application being submitted?	Yes	No
	of this application being submitted?
57.	Does the application include a completed “FEE DETERMINATION	Yes	No
	FOR CONSTRUCTION PERMIT APPLICATION,” Form 197-FEE,	Yes	No
	FOR CONSTRUCTION PERMIT APPLICATION,” Form 197-FEE,
	for the emission units and control equipment for which a permit for
	construction or modification is being sought?
58.	Does the application include a check in the proper amount for	Yes	No
	payment of the Construction permit fee?	Yes	No
	payment of the Construction permit fee?

Note: Answering “No” to Items 36 through 58 may result in the application being deemed incomplete.

Signature Block

Pursuant to 35 IAC 201.159, all applications and supplements thereto shall be signed by the owner and operator of the source, or their authorized agent, and shall be accompanied by evidence of authority to sign the application. Applications without a signed certification will be deemed incomplete.

59. Authorized Signature:

I certify under penalty of law that, based on information and belief formed after reasonable inquiry, the statements and information contained in this application are true, accurate and complete and that I am a responsible official for the source, as defined by Section 39.5(1) of the Environmental Protection Act. In addition, the technical contact person identified above is authorized to submit (by hard copy and/or by electronic copy) any supplemental information related to this application that may be requested by the Illinois EPA.

BY:

_________________________________________________	_________________________________________________
AUTHORIZED SIGNATURE	TITLE OF SIGNATORY
_________________________________________________	_______________ / _______________ / _______________
TYPED OR PRINTED NAME OF SIGNATORY	DATE

IL 532-2865 APC628 9/07

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How to Edit Form Il 532 2865 Online for Free

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This form will need some specific details; in order to guarantee correctness, please be sure to consider the suggestions hereunder:

1. Complete the Form Il 532 2865 with a number of major blanks. Gather all of the required information and be sure absolutely nothing is forgotten!

Completing segment 1 in Form Il 532 2865

2. Your next step would be to fill in these particular blank fields: Description of source and, SIC or NAICS, Latitude DDMMSSSSSS, Longitude DDMMSSSSSS, If this information different, Applicant Information, Who is the applicant Owner, Operator, All correspondence to check one, Source Attention name andor title, Owner, Operator, This Agency is authorized to, Printed on Recycled Paper, and Page of.

Form Il 532 2865 conclusion process clarified (part 2)

3. The following segment is mostly about Name, Address, Owner Information, City, State, Zip code, If this information different, Operator Information If Different, Name, Address, City, State, Zip code, If this information different, and Preferred technical contact check - type in each of these empty form fields.

Zip code, Name, and Owner Information inside Form Il 532 2865

4. The following subsection requires your involvement in the following places: Applicants technical contact, Contact persons telephone number, Contact persons email address, Applicants consultant for, Consultants telephone number, Consultants email address, Review Of Contents of the, Is the emission unit covered by, constructed If yes provide the, Note The Illinois EPA is unable to, project, Does the application contain a, the emission units and air, Does the application include, and Yes. Be sure you provide all of the needed info to move forward.

Filling out section 4 in Form Il 532 2865

5. Since you draw near to the conclusion of this document, you'll notice a few more requirements that should be fulfilled. In particular, Does the application include, showing new and modified emission, If the project is at a source, permit from the BOA does the, Yes, Yes, IL APC, Printed on Recycled Paper, and Page of must all be filled in.

Printed on Recycled Paper, If the project is at a source, and permit from the BOA does the of Form Il 532 2865

Be very careful when completing Printed on Recycled Paper and If the project is at a source, as this is where most users make mistakes.

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